



Has your employment position changed since we last contacted you about a year ago?
(Please tick the box that best applies to you and follow the instructions).


(Please tick yes or no for each activity)
- | |
---|---|
1 - No 2 - Yes |
|
Kneeling or squatting for longer than 1 hour per day in total | |
Climbing a ladder | |
Climbing up and down more than 30 flights of stairs per day | |
Digging or shovelling | |
Lifting weights of 10kg (25lbs) or more by hand | |
Standing or walking for most of the day | |
Standing or walking for more than 3 hours at a time | |
Hard physical work that makes you hot or sweaty |


- | |
---|---|
1 - None of the time 2 - Rarely 3 - Some of the time 4 - Often 5 - All of the time |
|
I’ve been feeling optimistic about the future | |
I’ve been feeling useful | |
I’ve been feeling relaxed | |
I’ve been feeling interested in other people | |
I’ve had energy to spare | |
I’ve been dealing with problems well | |
I’ve been thinking clearly | |
I’ve been feeling good about myself | |
I’ve been feeling close to other people | |
I’ve been feeling confident | |
I’ve been able to make up my own mind about things | |
I’ve been feeling loved | |
I’ve been interested in new things | |
I’ve been feeling cheerful |
During the past 7 days | |
---|---|
1 - Rarely or none of the time (less than one day) 2 - Some or a little of the time (1-2 days) 3 - Occasionally or a moderate amount of the time (3 - 4 days) 4 - Most or all of the time (5-7 days) |
|
I was bothered by things that usually didn’t bother me | |
I did not feel like eating; my appetite was poor | |
I felt that I could not shake off feeling low, even with help from my family and/or friends | |
I felt I was just as good as other people | |
I had trouble keeping my mind on what I was doing | |
I felt depressed | |
I felt that everything I did was an effort | |
I felt hopeful about the future | |
I thought my life had been a failure | |
I felt fearful | |
My sleep was restless | |
I was happy | |
I talked less than usual | |
I felt lonely | |
People were unfriendly | |
I enjoyed life | |
I had crying spells | |
I felt sad | |
I felt that people dislike me | |
I could not get “going” |

Please complete the table, by circling the number in the appropriate box. Please circle a number on every line.
AVERAGE USE IN PAST 3 MONTHS | |
---|---|
0 - Never 1 - Less than once/ month 2 - 1-3 per month 3 - Once a week 4 - 2-4 per week 5 - 5-6 per week 6 - Once a day 7 - 2-3 per day 8 - 4-5 per day 9 - 6+ per day |
|
White bread (one slice) | |
Brown and wholemeal bread (one slice) | |
Biscuits eg digestive (one) | |
Apples (one fruit) | |
Bananas (one fruit) | |
Melon, pineapple, kiwi and other tropical fruits (medium serving) | |
Green salad eg lettuce, cucumber, celery | |
Garlic – raw and cooked dishes | |
Marrow and courgettes | |
Peppers – cooked & fresh | |
Yogurt (125g pot) | |
Eggs as boiled, fried, scrambled etc. (one egg) | |
White fish eg cod, haddock, plaice, sole (not in batter/crumbs) | |
Oily fish, eg. mackerel, tuna, salmon | |
Bacon and Gammon | |
Meat pies, eg. pork pie, pasties, steak & kidney, sausage rolls | |
Boiled, mashed and jacket potatoes (one egg size potato) | |
Chips | |
Pasta eg spaghetti, macaroni |
Approximately how many times, over the past 3 months, have you have eaten each of the particular foods found within the table below. FOOD AND AMOUNTS Which is the main spreading fat you have used for example on bread, toast or vegetables? Spreading fat (teaspoon) Please name the spreading fat you use - ... AVERAGE USE IN PAST 3 MONTHS
Please complete the table, by circling the number in the appropriate box. Please circle a number on every line.
In the table below, please write in, on average, how much of each milk type you have consumed per day, over the past 3 months.




heaf_16_fup3
Section One: About Yourself and Your Work
In an average week, roughly how many hours would you spend doing the following activities? (Please answer each question)
Hours per week | |
---|---|
Hours in week | |
Working in a paid job (whether employed or self-employed) | |
Giving personal care to someone in your home or family | |
Working in an unpaid job for others outside your home and family (e.g. as a volunteer for a charity) | |
Doing hobbies |
In an average week, and outside any paid jobs that you do, roughly how many hours would you spend doing the following activities? (Please answer each question)
Hours per week | |
---|---|
Hours in week | |
Physical activities sufficient to make you hot or sweaty (e.g. heavy gardening, dancing, cycling, jogging) | |
Meeting or doing things with friends or relatives who do not live in your home |
In your main job, does an average day at work involve any of the following activities?
- | |
---|---|
1 - No 2 - Yes |
|
Kneeling or squatting for longer than 1 hour per day in total | |
Climbing a ladder | |
Climbing up and down more than 30 flights of stairs per day | |
Digging or shovelling | |
Lifting weights of 10kg (25lbs) or more by hand | |
Standing or walking for most of the day | |
Standing or walking for more than 3 hours at a time | |
Hard physical work that makes you hot or sweaty |
Section Two: Personal Finance
Have you ever received any of the following benefits? (Please tick all that apply)
- | |
---|---|
1 - yes |
|
Incapacity benefit | |
Invalidity benefit | |
Disability Living Allowance (DLA) | |
Severe Disablement Allowance | |
Personal Independence Payment (PIP) | |
Employment and Support Allowance (ESA) | |
None of the above |
Section Three: Health
Below are some statements about feelings and thoughts. Please tick the box in each row that best describes your experience of each over the last 2 weeks (One tick for each row)
- | |
---|---|
1 - None of the time 2 - Rarely 3 - Some of the time 4 - Often 5 - All of the time |
|
I’ve been feeling optimistic about the future | |
I’ve been feeling useful | |
I’ve been feeling relaxed | |
I’ve been feeling interested in other people | |
I’ve had energy to spare | |
I’ve been dealing with problems well | |
I’ve been thinking clearly | |
I’ve been feeling good about myself | |
I’ve been feeling close to other people | |
I’ve been feeling confident | |
I’ve been able to make up my own mind about things | |
I’ve been feeling loved | |
I’ve been interested in new things | |
I’ve been feeling cheerful |
Do you have difficulty with any of the following activities? (One tick for each row)
- | |
---|---|
1 - No problem 2 - Mild Problem 3 - Moderate Problem 4 - Severe Problem |
|
Walking | |
Getting up from sitting | |
Opening jars that have never been opened |
How much have you been troubled by the following sleep problems in the past 3 months?
- | |
---|---|
1 - No problem 2 - Mild Problem 3 - Moderate Problem 4 - Severe Problem |
|
Difficulty falling asleep | |
Difficulty staying asleep | |
Waking up too early | |
Not feeling refreshed in the morning |
Below is a list of ways you might have felt or behaved – please tell us how often you have felt this way during the past 7 days including today (One tick for each row)
During the past 7 days | |
---|---|
1 - Rarely or none of the time (less than one day) 2 - Some or a little of the time (1-2 days) 3 - Occasionally or a moderate amount of the time (3 - 4 days) 4 - Most or all of the time (5-7 days) |
|
I was bothered by things that usually didn’t bother me | |
I did not feel like eating; my appetite was poor | |
I felt that I could not shake off feeling low, even with help from my family and/or friends | |
I felt I was just as good as other people | |
I had trouble keeping my mind on what I was doing | |
I felt depressed | |
I felt that everything I did was an effort | |
I felt hopeful about the future | |
I thought my life had been a failure | |
I felt fearful | |
My sleep was restless | |
I was happy | |
I talked less than usual | |
I felt lonely | |
People were unfriendly | |
I enjoyed life | |
I had crying spells | |
I felt sad | |
I felt that people dislike me | |
I could not get “going” |
Approximately how many times, over the past 3 months, have you have eaten each of the particular foods found within the table below.
AVERAGE USE IN PAST 3 MONTHS | |
---|---|
0 - Never 1 - Less than once/ month 2 - 1-3 per month 3 - Once a week 4 - 2-4 per week 5 - 5-6 per week 6 - Once a day 7 - 2-3 per day 8 - 4-5 per day 9 - 6+ per day |
|
White bread (one slice) | |
Brown and wholemeal bread (one slice) | |
Biscuits eg digestive (one) | |
Apples (one fruit) | |
Bananas (one fruit) | |
Melon, pineapple, kiwi and other tropical fruits (medium serving) | |
Green salad eg lettuce, cucumber, celery | |
Garlic – raw and cooked dishes | |
Marrow and courgettes | |
Peppers – cooked & fresh | |
Yogurt (125g pot) | |
Eggs as boiled, fried, scrambled etc. (one egg) | |
White fish eg cod, haddock, plaice, sole (not in batter/crumbs) | |
Oily fish, eg. mackerel, tuna, salmon | |
Bacon and Gammon | |
Meat pies, eg. pork pie, pasties, steak & kidney, sausage rolls | |
Boiled, mashed and jacket potatoes (one egg size potato) | |
Chips | |
Pasta eg spaghetti, macaroni |
Which types of milk have you used regularly in drinks and added to breakfast cereals over the past three months?
Please tick | On average, over the past 3 months, how much milk have you consumed per day? | |
---|---|---|
1 - tick Pints per day |
1 - tick Pints per day |
|
Whole pasteurised or UHT | ||
Semi-skimmed pasteurised (include 1% milks) or UHT | ||
Skimmed pasteurised or UHT | ||
Other (Please specify) | ||
None (go to Q68) |
HEAF Follow-up 3